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Switching from Tenofovir to Baraclude
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Switching from Tenofovir to Baraclude

Hi every body. Please guide me.
I am suffering from chronic hepatitis b. I took tenofovir for 7 months in 2012 after which I discontinued it for 6 months (did not take any other drug for treatment of hepatitis B during that 6 months period). Then when I tested my result was so bad:
viral load: 4.47x10^4 IU/mL (2.6x10^5 copy/mL)
GOT 45 U/L (higher than normal)
GPT 108 U/L (higher than normal)

After this based on my doctor`s recommendation, I started taking Viread (Tenofovir) again, in April 2013. After that I have been testing my blood regularly. It is 10 months since I have been using it again.It has been effective in reducing the HBV numbers but unfortunately the ALT/AST levels are going higher by the passage of time. These are my results date wise:
October 2013:
GOT 36 U/L (little higher than normal)
GPT 87 U/L (little higher than normal)
HBV DNA 2.00x 10^1 (very low)

January 2014:
SGOT (AST) 134 U/L (very high)
SGPT (ALT) 188 U/L (very high)

Now, it is about a year that the ALT/AST levels (liver damages?) are higher than normal despite using Viread (Tenofovir). My doctor says the virus has become mutant and very active. Therefore now my doctor has recommended me to use combo drugs of Tenofovir+Baraclude for the next 6 months and he is sure the ALT/AST will be normal in this way. My doctor says after 6 months of using the combo I can drop Tenofovir and continue with Baraclude.  
Now my questions from you dears is that:
1) What do you think about my ALT/AST and the way it is being treated and if you disagree what is your suggested way, please?
2) If the virus is mutant, is it the best way of its treatment? If no then what?
3) I am very worried about the side effects and chances of developing Cirrosis (cirrhosis). What do you think in this regard and your suggestions, please?
4) It is 6 days that I am taking the combo (tenofovir+baraclude) but since yesterday I am dizzy and light headed. What does it mean? and how much is the chances of lactic acidosis?

I am waiting crazily for your response and guidance please.

Dear Stef2011, I love your comments please take the trouble to respond to this post. Thanks.
5 Comments Post a Comment
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Avatar_m_tn

keep the combo tenofovir plus entecavir, your doctor sounds extremely ignorant about hbv, it is correct to do the combo but it is not correct to keep entecavir only

ast-alt have nothing to do with liver damage and those number are not high, having abnormal alt while hbvdna undetectable on antivirals means you have a active immune system which is detecting infected cells and it is very good because it lowers hbsag faster

to judge your response to antivirals you need at least 1-2 years but it is correct to do the combo if hbvdna is not undetectable after 6-12 months

what is your fibroscan?this is what shows liver damage and not blood tests only

what is your hbsag quantitative in iu/ml?

and of course you need to take antivirals for life unless hbsag turns negative or you add on pegintf after 4-5 years on antivirals and hbsag goes und
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Avatar_m_tn
Stef2011 thank you.

I have not done any Fibroscan and Hbsag quantitative in iu/ml tests yet. For sure I am going to discuss these tests with my doctor during my next visit and try to do them if available.

But before starting the Baraclude add on, I did not do a test for viral load. The only results that caused this decision were the ALT and AST being higher than normal for long period of a year. My last viral load test happened three months ago on Oct 2013 in which hbv dna was not undetectable that was 20 copies. In this case do you think that was a mustake not to test viral load before going on combo? I have been using the combo for 7 days now.

And what does it mean the virus is mutant? and is this a proper way of treating mutant virus?

Thanks again Stef2011 and waiting for your response, please.




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Avatar_m_tn
with your elevated ALT you need to monitor your hbsag in quantity to understand what is going on with your hbv status. Fibroscan monitoring would be usefull to see if your elevated ALT makes liver damage. There are studies indicating that ALT flare during interferon theraphy is a good sign but I had never seen studies on ALT flare during NUCs.

http://www.ncbi.nlm.nih.gov/pubmed/11679974
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Avatar_m_tn
Thanks andrey19. I will try to get Hbsag quantitative and fibroscan if available.

However, guys something is not clear to me. That is

Do I have to be careful about my diet in my condition?

Does sex adversly affect the disease?

And how about heavy exercise at gym? Is it responsible for worsening of ALT/AST in my case?

Stef2011 and others, what do you think?
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Avatar_m_tn
hi, please share the following data

- age
- are u a carrier since birth?
- hbeag status: if it is positive you may have enetered into the serconversion phase leading to eag negative and hopefully low/end DNA
- haev u ever had an ultrasound test done?
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